Assessment of GH status in acromegaly using serum growth hormone, serum insulin‐like growth factor‐I and urinary growth hormone excretion

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Abstract
Summary: OBJECTIVE It Is still not clear what Is the most suitable method for monitoring progress of acromegaly. The aim of this study was to assess the relative merits of serum GH, serum IGF‐I and urinary GH (uGH) excretion in the follow‐up of acromegalic subjects.SUBJECTS AND METHODS Thirty‐six acromegalic patients each had a GH day series performed consisting of five serum GH measurements, together with an estimate of serum IGF‐I and uGH. The first sample taken for serum GH was fasting (basal) whilst the third (1430 h) was arbitrarily chosen as a random value. uGH was measured from two overnight collections and the mean value used for subsequent data analysis.MEASUREMENTS Serum GH and IGF‐I were measured by radioimmunoassay whilst uGH was estimated by an Immunoradlometric assay using commercially available reagents.RESULTS There is a highly significant linear correlation between serum GH and IGF‐I following log transformation of these two variables (r=0.85; Pr=0.78; Pr=0.81; P5mU/l. We have identified a number of patients, however, with persistent elevation of IGF‐I in the presence of serum GH<5mU/l and normal uGH. Until the significance of these findings with respect to long‐term outcome is known, serum GH should continue to be used In the follow‐up of these patients. An alternative, which reflects integrated overnight GH secretion, Is uGH which is convenient and easy to collect as an outpatient and correlates strongly with serum GH.CONCLUSION Acromegalic patients can be conveniently followed on an outpatient basis using a combination of uGH and serum IGF‐I. Measurements of serum GH can be reserved for those with discrepant results.

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